The object of this blog began as a display of a varied amount of writings, scribblings and rantings that can be easily analysed by technology today to present the users with a clearer picture of the state of their minds, based on tests run on their input and their uses of the technology we are advocating with www.projectbrainsaver.com

Cecilia W.yu explores the deep connections between graffiti as an art form and the 6,000 yrs old Chinese pictorial language. The great chinese calligraphers used to hang around the Imperial Court but were often described as “Classy but useless!” (a common description of their works by bureaucrats and illiterates alike)…..but 6,000 years later every surname and every word of the Chinese language has evolved from their scribbles.

In the Absence of International Consequences, High Court of Appeal Upholds Politically Motivated Sentences

Against Leading Human Rights and Political Leaders

On September 4th, 2012, the High Court of Appeal in Bahrain ruled to uphold all of the sentences against the so-called “accused conspirators” in the case of the 13 human rights defenders and political leaders serving time in prison and the 7 tried in absentia.

Before looking into the details of the flawed appeal process, it is crucial to note that according to reports and statements made by international human rights organizations, these prisoners of conscience should not have been imprisoned to begin with, let alone made to go through several prolonged judicial processes. The Bahrain Center for Human Rights and the Gulf Center for Human Rights have previously noted that these processes are used as a tool for judicial harassment and used to buy time and keep these prisoners of conscience in prison for longer periods.

The BICI report in November 2011 clearly stated that all charges against defendants relating to freedom of speech or freedom of expression must be dropped. This decision is a clear rejection of that principle, and a serious violation of human rights. All of the charges brought against these defendants are related to freedom of expression, and must be thrown out.

All sentences against the prisoners of conscience were upheld, as well as charges such as breaching the Constitution and participating in a plot to overthrow the regime and having intelligence contact with foreign entities. For case background please refer to:bahrainrights.hopto.org/en/node/5272

Three of the prisoners of conscience, namely Abdullah Isa Mahroos, Mohammed Hasan Jawad and Salah Abdullah AlKhawaja, were acquitted of the charge of participating in plot to overthrow the regime. Their sentences, though, were not amended.

Hasan Radhi, one of the leading lawyers involved in this case, spoke during a press conference today, and pointed out many of the outstanding violations that characterized the appeal process:

1. Not all of the defense witnesses were heard.2. The confessions that were extracted under torture were not thrown out.3. There was no investigation into the torture allegations, which were detailed in some of the statements made by leading human rights defender Abdulhadi Al-Khawaja and other prisoners of conscience at the beginning of the appeal process. The failure to investigate these allegations implicates the officials who were made aware of these violations.4. The last several hearings were held in secrecy, with a gag order on the press ()5. The court appointed new lawyers after the defendants requested their own lawyers to withdraw from the process in protest of the deeply flawed process. The new lawyers were assigned against the will of the defendants, which was a violation of their constitutional rights.6. The appeal process was unusually swift.

Statements from Governments:

President Obama made clear in a speech on 19th May, 2011, when referring to Bahrain, that “you can’t have a real dialogue when parts of the peaceful opposition are in jail.”Link: whitehouse.gov

In a statement yesterday, Acting Deputy Spokesperson for the White House stated that the US is “troubled” by the appeal verdict: Link: state.gov

The BCHR and GCHR welcome the statement from Jeppe Kofod, the foreign policy spokesperson for the Social Democrats – Denmark’s ruling party – who stated in regards to the court’s decision that “It is deeply tragic and deplorable. I had hoped the Bahraini rule had deliberated further and released Al-Khawaja. It is deeply disappointing, and we need to think about what kind of sanctions we can take against Bahrain.”Link: i-m-s.dk

The BCHR and GCHR have previously stated that the continuation of human rights violations in Bahrain are a result of international silence and a general lack of consequences for the government in Bahrain. A discussion on possible economic and/or diplomatic sanctions will have a huge influence on preserving human rights in Bahrain.

The Danish Foreign Minister, Villy Søvndal, was quoted in the Washington Post as saying “the decision to uphold the life sentence “very disappointing” and said he would discuss possible further international action from “the very broad range of countries that in the spring supported Denmark in the demand for the release of Al-Khawaja and the other human rights and democracy fighters in Bahrain.”Link: washingtonpost.com

Statements from International and Local Human Rights Organizations:

The Human Rights Watch report on the original trial process and charges:hrw.orgJoe Stork of Human Rights Watch stated that the initial court ruling “only compounds the travesty of justice that has characterized this case from the beginning.” Their report calls attention to the fact that all of the charges were related to the defendants exercising their right to peaceful expression, association, and assembly.

The international community was quick to respond to the court’s announcement. Amnesty International called these defendants prisoners of conscience, and demanded their immediate release.Link: amnesty.org

In May 2012, an appeal signed by more than 100 organizations called to end the assault on freedom of speech, and to free all detained human rights defenders and citizens.Link: ifex.org

The BCHR and GCHR call on the US administration as well as other governments that have influence in Bahrain including the UK government, the EU and leading human rights organizations to:

1. Call for the immediate release of all prisoners of conscience in Bahrain.2. Increase the pressure on the Government of Bahrain to stop the ongoing daily human rights violations as well as escalating attacks on human rights defenders.3. Put pressure on the Government in Bahrain to allow journalists and human rights organizations access to the country to document human rights violations and to report on the ongoing situation.4. Immediately stop all arms sales to the Government of Bahrain due to the continuous human rights violations.5. Initiate a discussion on international consequences, including but not limited to diplomatic and economic sanctions, towards the Government of Bahrain due to the continuation of human rights violations.

The BCHR and GCHR urge the United Nations to:

1. Hold a special session on Bahrain at the Human Rights Council, and a session to follow up on the implementation or lack thereof of the recommendations of the BICI report.2. Call for a follow up fact-finding mission to look into the widespread and continuous human rights violations that have taken place since the issuing the BICI report November 2011.3. Put pressure on the Government of Bahrain to accept requests for visits from the UN special rapporteurs.

Haiti, an already very poor country, was shattered by the earthquake of January 2010 centred on the capital, Port-au-Prince. In the aftermath, a rigorous economic programme was imposed by rich-world agencies and governments that took no account of Haitians' true needs. A forensic investigation of how this blueprint has overridden the hopes of a new generation of Haitians, by Matt Kennard.

"In the Western hemisphere, in Haiti and elsewhere, we live under the shadow of your great and prosperous country. Much patience and courage is needed to keep one´s head" - Doctor Maigot to Mrs Smith in Graham Greene's The Comedians

In the middle of Port-au-Prince, along a dusty road and behind some imposing metal gates, sits the E-Power electricity plant. In a capital city where electricity blackouts are a nightly occurrence, E-Power is the kind of company the international financial institutions (IFIs) running Haiti believe will lead "reform" - by taking power away from the state-run company, and running it for profit. The company was founded in 2004 by a group of Haitian venture capitalists excited by the departure of social-democratic president Jean-Bertrand Aristide. The aim, it said, was to "offer a solution to power generation in Haiti". Sure enough, two years later, in 2006, the new United States-backed president, René Préval, launched an open bid for a contract to provide electricity to Haiti's capital city. Seven companies took part: E-Power won.

For many in the Haitian business elite, such economic liberalisation should now be the model for the new Haiti being built after the devastating earthquake of 12 January 2010. "The earthquake created trauma that could have been better exploited", Pierre-Marie Boisson, board director at E-Power, tells me as we sit in the upmarket offices at the plant. "Because of the political process that took place after that, it took too much time." He adds: "Earthquakes should be an opportunity because they destroy. Where earhquakes destroy, we have to build. When we have to build we can create jobs, we can create a lot of changes, we can change a country."

However, Mr Boisson’s cynicism about the slow rate of "exploitation" is not quite accurate. In the aftermath of the earthquake, the opportunity afforded by the destruction wreaked on Haiti was, in fact, pounced on immediately - and to stunning effect.

As the dust was still settling in Port-au-Prince, the IFIs and various US agencies - what became the de facto government in the absence of a Haitian alternative - carved up the society’s different sectors and doled them out amongst themselves. The Inter-American Development Bank (IADB) got education and water; the World Bank bagged energy; the United States Agency for International Development (Usaid) gratefully accepted the planned new industrial parks. Alexandre Abrantes, the World Bank’s special envoy to Haiti, tells me how it worked: "We basically have agreed that where we have each of us the competitive advantage, we then divide … the sectors among ourselves, and add in some sectors which go together."

The mass privatisation of state-run assets and the turning of Haiti into a "Caribbean sweatshop" - via an export-led garment-production and cheap-labour model - was something that the US and the IFIs had been pushing forcefully from the mid-1990s through the 2000s. Now its realisation became a distinct possibility. They could enforce it with minimal pushback from a decimated civil society and a denuded government. All the extra-Haitian bodies, particularly the US government, saw the same vision, which made it even easier. "There is a lot of agreement, so I would say one of the unusual and very positive aspects about this project is that it is really done in partnership", Jean-Louis Warnholz, a state-department official working on Haiti, tells me.

The "partnership" believed that rebuilding the capabilities of the Haitian state should play no role in the reconstruction. The panacea to Haiti’s problems lay in the creation of a flourishing private sector. "What’s really going to change Haiti and make this process different from all the previous ones is [the] development of the private sector, and I think there’s a consensus in that", Agustín Aguerre, the Haiti manager for the Inter-American Development Bank (IADB), tells me. The bank disbursed $177bn in grant money in 2010, more than any other multilateral source, to push this agenda. "Private sector is the big difference, it’s what will be creating wealth, creating jobs, not the public sector", Mr Aguerre adds.

Even after the election of Michel Martelly as Haiti's president in March-April 2011, things remained easy for this private-sector-led "consensus": the IFIs and US not only had their "shock event", but also their "shock president". (Aristide - who was president in 1991, 1993-94, 1994-96, and 2001-04, continues to be the most popular politician in Haiti, but is banned from standing again for the presidency). In the Martelly administration, the US had found their "Chicago boy", a more-than-willing partner for their economic programme. All the major business groupings and IFIs I spoke to in Port-au-Prince were effusive in their support for the president. Carl-Auguste Boisson, general manager at E-Power, says: "I am pleased by what I heard Martelly saying about the importance of private investment, especially when he was campaigning he was talking about things like providing private provision of public services."

Kenneth Merten, the former United States ambassador to Haiti, is similarly excited about the new president’s privatisation agenda. "A few privatisations of flour mills, but aside from that you haven’t had much of anything in past decades," he tells me. "That’s the element that’s been lacking here, you need a government that understand investment and I think Martelly and his folks do." For the US, a pliable figure like Martelly had been a long time coming. Despite many decades of effort, Haiti had not completely succumbed to the plans that its major patron had for it. And such recalcitrance had been causing increasing consternation in Washington.

The long history

In the 1990s the pace of economic reform in Haiti was not fast enough for Washington government or the powerful IFIs that were together trying to radically alter the face of the country. After the first democratic elections in the country’s 200-year history in 1990, the US was hopeful about breaking up the corrupt state institutions which had been run as the personal fiefdoms of "Papa Doc" and "Baby Doc", the US-backed Duvalier dictators that had ruled viciously for nearly forty years. Private capital would then be able to penetrate deeper into Haiti, and an economic model conducive to the interests of the rich countries could take firm root.

But it wasn’t going to plan. Instead of the US-orientated "reformer" many in Washington had hoped for, a huge mass movement, named Lavalas ("Flood’), propelled the social-democrat priest, Jean-Bertrand Aristide, to a landslide victory in 1990. Over the next twenty years, Aristide would be ousted twice (with US support), and the democratic hopes and dreams of its people would be quashed time and again.

With the nuisance of Aristide, and all the attendant turmoil in the country, it remained hard for the US and its allies in the International Monetary Fund and World Bank to transform Haiti according to the neoliberal model in the way they had envisioned. When Aristide was put back in power in 2001 he did so with the tacit agreement that he would allow the US and Bretton Woods institutions to institute their plan. It had been eleven years since the democratic elections, and still economic "reform" was slow. Something had to change.

In this period, René Préval, a former ally of Aristide who served as president from 2006-11, seemed to offer some hope for the Americans. "In the context of the developing world, we would most accurately describe him as a neoliberal, particularly in that he has embraced free markets and foreign investment", notes one of the US embassy’s diplomatic cables sent from Port-au-Prince in 2007.

But the leader the US was really after in that period looked more like Haitian-American businessman Dumas Simeus. A resident of Texas, he assured the US embassy, according to a diplomatic cable of 2005, that "he would manage Haiti like a business". The same cable added: "Displaying abundant charm and energy, the 65-year-old said he had decided to run for President not only for Haiti’s benefit, but also as a gesture of thanks to the United States." He was very clear about he would do this: "The University of Chicago alum pledged to bring the 'Chicago boys' to Haiti and establish a road map for change, promising investors would return."

It was exactly what the US embassy wanted to hear; Simeus was the candidate they had been searching for. The cable concluded by noting that the millionaire Texan is a "potentially viable candidate" who could, unlike Aristide, "govern responsibly and maybe effectively" - that is, in the US interest. The US now deems Martelly similarly "responsible".

But in many ways, the US exasperation at the apparent reluctance of Haiti’s leaders to sell off their country’s assets, and create an economic playground for foreign capital, remains hard to understand. From the mid-1990s through the 2000s, the "Chicago boys" had to all intents and purposes come to Haiti; the process of opening up Haiti’s economy to the predations of foreign capital was well underway. In 1996, the Haitian government had already, one diplomatic cable published by Wikileaks notes, "established legislation on the modernization of public enterprises, which allows foreign investors to participate in the management and/or ownership of state-owned enterprises."

Moreover, a law of November 2002 explicitly acknowledged the "crucial role of foreign investment in assuring economic growth and aims to facilitate, liberalize, and stimulate private investment in Haiti." The law gave foreign investors exactly the same rights and protections as Haitians. A few months earlier in 2002, the Haitian parliament had voted for a new free-trade-zone law which provided "zones" with fiscal and customs incentives for foreign enterprises - for example, a fifteen-year tax exemption. In other words, post-Aristide, the government had "seen the light" and embraced the US and Bretton Woods vision for post-dictatorship Haiti. But like a recidivist addict, these steps were never to be enough to sate the US and the IFIs. They wanted their "Chicago boy".

A good example of this greed comes from the Wikileaks cables, one of which notes that in 1996 a "modernization commission" was set up to decide whether management contracts, long-term leases or capitalisation was the best option for each of the companies to be privatised. The commission would also set how much the Haitian government would retain of the asset, with a cap at 49% - a minority stake, stripping the Haitian people of control over their own industries. This had an immediate effect. In 1998, two US companies, Seaboard and Continental Grain, purchased 70% of the state-owned flour mill.

But despite this "progress", a diplomatic cable from 2005 lamented: "Some investments, however, still require government authorization". It added: "Investments in electricity, water and telecommunications require both government concession and approval. Additionally, investments in the public health sector must first receive authorization from the Ministry of Public Health and Population." It sounded like a normal sovereign country, but a sovereign country is exactly what the the US and IFIs didn’t want Haiti to be. Two years after Aristide had been spirited out of the country, and just before the victory the "neoliberal" Preval in 2006, the US embassy noted witheringly: "Since the privatization of the cement factory, privatization has stalled and appears to have been put on hold." It went on, plaintively: "None of the major infrastructure-related enterprises (the airport, seaport, telephone company or electric company) have been privatized."

The document continued: "Although these entities were supposed to have been privatized by 2002, persistent political crises, strong opposition from the former administration, and a general lack of political will have delayed the process indefinitely." The cable then notes a more plausible reason why this massive privatisation programme had not been enacted quite as smoothly as the US had hoped: "Some opposition to the privatization of state enterprises continues from groups such as employee's unions who have expressed opposition to workforce reductions that privatization might entail."

By 2008, then, the US embassy was disconsolate at the slow rate of progress and intransigence from the Haitians. "Despite assurances that privatization is a still a priority for the government …we are increasingly skeptical that privatization, in whatever form, will happen", one cable noted. "Time is running out." The US, however, remained steadfast to its goal. "We will continue to advocate strongly on behalf of privatization and/or private management", one cable noted. It further advocated using the Bretton Woods institutions to bribe the democratic government of Haiti. "[The US embassy] repeats its recommendation … that privatization be a requirement under future agreements with the IFIs … to be negotiated with the new government."

The shock

Bribery might prove an effective strategy for the poorest country in the western hemisphere, but it would still be messy. There was after all a Haitian parliament, populated with nationalist elements, which could continue to stall or even kill the massive privatisation programme the US favoured. But as the US was honing its strategy for its latest push, on 12 January 2010 a huge earthquake hit Port-au-Prince and surrounding areas, creating one of the worst humanitarian crises in the history of the world. More than 300,000 people were killed, while millions became homeless. The capital city lay in ruins, including the majority of government ministries as well as the presidential palace. What was left of an already strangled civil society and social institutions was destroyed. Haiti was a blank slate.

The US and its allies in the IMF and World Bank did not waste any time in realising that this was the opportunity to push through their radical neoliberal programme from the 1990s with little resistance. The opposition to this privatisation programme - which had ranged from quasi-nationalist politicians to worker-based collectives - had all but disappeared. Without a government in place to agree or disagree with the US and the IFIs, which were soon running the country, Haiti was ready for the "shock doctrine" - the radical economic prescriptions enforced throughout the world and outlined in Naomi Klein’s eponymous book.

The first step was to entrench a decision-making system which took all power out of the hands of accountable democratic institutions run by Haitians. The Interim Haiti Recovery Commission (IHRC), which became the country’s most powerful decision-making body in the aftermath of the earthquake, was the perfect example of this move. The IHRC was set up ostensibly to coordinate the response and spend the donor money in the absence of a Haitian government. It had twenty-six members, of which twelve were Haitian, leaving them without a voting majority (just as they were not allowed a majority stake in their industries). To those Haitian members, it was obvious they were window-dressing.

In a December 2010 letter of protest to the IHRC chair, former US president Bill Clinton, they complained of being "completely disconnected from the activities of the IHRC", as well as having "time neither to read, nor analyze, nor understand - and much less respond intelligently - to projects submitted." According to one journalist based in Port-au-Prince: "These twelve board members surmised that their only function is to rubber-stamp, as Haitian-approved, decisions already made by the executive committee."

This was exactly the perception that the US and the IFIs were trying to avoid. When officials from the US and international agencies in Haiti are interviewed they are at pains to explain how they are "working for the Haitians" and the phrase of the day is "Haitian-led". In truth, there was, and continues to be, minimal Haitian involvement in the reconstruction (outside of the business elite). An article in the Washington Post put it bluntly in January 2011: "There is a dramatic power imbalance between the international community - under U.S. leadership - and Haiti. The former monopolizes economic and political power and calls all the shots." The financial benefits to the American private sector of this set-up was immediately obvious. An AP investigation found that of every $100 of Haiti reconstruction contracts awarded by the American government, $98.40 returned to American companies. The focus was never on building up indigenous capacity - any work was to be outsourced to foreign companies or NGOs by the IHRC.

After Michel Martelly was sworn in as president in May 2011 it took months for the former pop star and member of the "tonton macoute" militia to form a government, as his candidates for cabinet positions were repeatedly rejected by parliament. By the time his administration was in place in June 2011, eighteen months after the earthquake, the coordinates of the economic reconstruction were already in place. Martelly’s hands were tied by the very IFIs who claimed to be subordinate to the Haitians. Though in Martelly’s case his hands didn’t even need to be tied - he was a willing "shock president".

The neoliberal model

The three factors that the US and IFIs wanted to build the "new Haiti" around were high-end tourism; export-processing zones; and a resurgent private sector in control of the previously-state owned assets.

The managers of the reconstruction had a couple of countries in mind which they believed could serve as a model. One was the Dominican Republic, the country next door to Haiti, which had long been an oasis of calm for private capital in the Caribbean. In Haiti, using the model of its Hispaniola neighbour, the IADB planned to spend $22m on a high-end tourism resort near the 19th-century citadel at Labadee, a port on Haiti’s northern coast. Mr Almedia, Haiti manager for the IADB, told me the bank’s money will "provide the means for the private sector to come and invest", adding that "in [the Dominican Republic] everything they have is all private. The airport is private, the roads are private, even the internal roads. So we could do the same thing [in Haiti]." (In the initial carve up of Haiti society, the IADB was given road infrastructure.)

The other opportunity that had to be taken advantage of was speeding up the privatisation process. The World Bank used the example of Teleco, formerly the national telecom operator, which in 2009 the bank’s private sector arm had helped partially privatise. Mr Naim, the private-sector Haiti manager for the World Bank, told me Teleco is an example of what the government should do now to the ports and airport. "[They can] really transform these assets that generally the government handles poorly", he says, adding that "It’s better for the government to focus on social things" and let these assets be privatised.

Teleco itself is now due for complete privatisation under the guidance of the World Bank’s private-sector arm, the IFC. For the poorest country in the western hemisphere, it was hard - possibly even suicidal - to argue with the World Bank tells you. In March 2010, the bank promised $479m in grants; the IFC put $49m worth of direct investment into Haiti’s private sector.

With Teleco on its way to privatisation, the IADB had its own plans for the national water and sanitation authority (Dinepa), which had come under its domain in the initial carve-up. The bank soon handed over the authority’s management duties to the giant Spanish company, Agua de Barcelona, which won a three-year contract to train and assist worker,s for which they received millions of dollars. "Many local companies are taking control of small towns' water systems", Mr Aguerre of the IADB tells me excitedly. This essential commodity and basic human right was now being turned into a for-profit venture. "We are seeing good examples of places where no one paid for water services, and little by little they are paying", adds Mr Aguerre. Experts from Agua de Barcelona became the leaders of discussions concerning the investment needed in Haiti’s water system and the process of opening bids to different contractors for the completion of new pipelines and other systemic improvements.

In education, the IADB’s plans were no different. Thanks to decades of neoliberal policies which prioritised the private sector above the Haitian ministries, even before the earthquake 80% of educational services were delivered outside of the state (primarily by international bodies or the private sector). As a result only half of school-age children in Haiti went to school. For the IADB, this did not prove the folly of their enterprise. Contrariwise, they concluded that it meant they had not gone far enough. "It’s too ambitious to think you can turn it around", Mr Aguerre says.

The IADB settled on a voucher programme that allows the government to retain some "quality control", but meant education would be completely privately-run. To ensure full access, the plan would create a publicly-funded but privately-run education system. The small print was that this public subsidy would cost the Haitian government about $700m a year, seven times the $100m it spends now on education. With no new revenue streams evident (in fact, as we shall see, the government’s tax base was being all but destroyed), the obvious implication was that full access was not an aim (or even a hope). When the IADB’s promised $500m over three years runs dry, more than half of Haiti’s children will still be locked out of the school system.

The IADB rationalised this arrangement by arguing that the private sector would pick up the slack - explicitly holding Haiti’s kids ransom to Hollywood film stars. "There are many private actors willing to put money in", added Mr Aguerre. "Half of Hollywood is interested. Everyone wants their Susan Sarandon School of Arts." Incidentally, the "shock president" Martelly has been approving of both vouchers and subsidising private schools as methods to rebuild the Haitian education system.

With the complete privatisation of the telecoms, water, education, the final piece in the jigsaw for the IFIs and the US was new "industrial parks" or "integrated economic zones". These, so the propaganda went, would ensure the economic growth that could put Haiti and its people back on their feet.

The cell approach

The thirty-minute drive to Codevi industrial park from the airport in northern Haiti is the smoothest in the country. In a place famed for its poor infrastructure - particularly the undulating roads – the park and the surrounding area are something of an oasis. Beyond the small bridge and metal gates which divide Codevi from the town outside, there’s everything that the average Haitian doesn’t have: paved roads, a functioning health service, employment, and even a (small) trade union – the only one in the country.

The two million square-foot Codevi park was originally built by a Dominican textile company, Grupo M, on the Dominican side of the border, but operations were expanded to Haiti in 2003 (with the help of a large investment by the World Bank). "It was created as a vision of expansion that Grupo M had to look for as the Dominican Republic became more complicated competitiveness-wise", Joseph Blumberg, vice-president of sales for the company, tells me as he sits in his air-conditioned office inside the park. "Haiti offered us the competitive edge that we needed in this region to maintain ourselves with the US market." He adds, "It had a labour cost which was the lowest in the region." The minimum wage in Haiti now is 150 gourdes ($3.70), which is nearly half that in the Dominican Republic.

This competitive advantage - in a lay person's terms "slave wages" and favourable trading terms with the US - had caught the eye of the IFIs in the aftermath of the earthquake. The aim was to rebuild Haiti as a "Caribbean sweatshop" that could enjoy the full fruits of the Haitian Hemispheric Opportunity through Partnership Encouragement (Hope) Act, which was passed by the US Congress in 2006, granting tariff-free access for Haitian textile exporters to the US market. This had been followed by increasingly favourable terms through Hope II, in 2008, and the Help Act after the 2010 earthquake.

The parks like that at Codevi are known in the IFIs literature as "integration economic zones" (IEZs): places where infrastructure, welfare services and other services are provided behind imposing metal gates for the lucky few. The propaganda justifying them argued that prospective foreign investors put off by the decrepit or non-existent roads, electricity-grid and water system throughout Haiti would here have access to a ready-made mini-city. There was already a huge industrial park of this kind near the airport in Port-au-Prince called Sonapi, which is fully owned by the Haitian government and had nearly forty companies based there. But the new IEZs would be under the sole control of its initial investors - mainly USAID and the IDB.

This raised the question of what would happen outside these so-called "poles" of economic activity. What would the incentive be for the central government to develop infrastructure and social services through the country if they were being built on this micro-scale? And where would the money come from? Alexandre Abrantes, the World Bank's special envoy to Haiti, admits this is a problem; he tells me that industrial parks "may not be sustainable if you were to do it as a policy everywhere".

Codevi is essentially an "export-processing zone" where exports pay no tax to the central government and there is no customs duty on imported materials. "You’re in an extra-territorial concept so that your goods come in and out very quickly without much paperwork", adds Armando Heilbron, a senior private-sector development specialist at the World Bank working on the IEZs in Haiti. Therefore, Haiti’s reconstruction will be centred in isolated small cells - called "poles" by the economic managers - primarily around the northern part of the country, while the rest of the country’s infrastructure and welfare services will fall further into disrepair.

But maybe the biggest problem with the industrial parks is the unscrupulous nature of the companies that populate them. The public-relations tour of Codevi, with its stops at the local doctor and training facilities, is a relief after experiencing the destruction that has been wrought in the rest of the country. But that same tour did not include many of the most important episodes in its establishment. Codevi was originally built on farmers' land against their will - a process which literally destroyed the region’s agricultural infrastructure to create sweatshops. It was a parable for the economic reconstruction that occurred after the earthquake. The diplomatic cables recount that there had been a "long-standing labor dispute between Dominican manufacturer Grupo M and workers in Ouanaminthe". One says:

"According to Yannick Etienne, a labor representative, the fight has its origins in the closed-door negotiations that established the Free Trade Zone (FTZ). The farmers were left out of the negotiating process until the day of the FTZ ground breaking ceremony in 2002, when they were told their land was being expropriated. Grupo M eventually published a social compensation plan in 2003, however, it came too late for the farmers whose land was already gone, and whose suspicions of the Dominicans were already aroused."

Grupo M and their patrons at the World Bank do not tire of outlining the countless benefits which accrue to the local population because of Codevi. When I ask to speak to workers, two are dutifully brought out to give monosyllabic and mono-positive comments about their jobs, perhaps wary of the manager who sits next to them. Neither is a member of the union, I soon find out. In fact, Grupo M tells me it has no conception of how many workers are in the union. "Very little", is all Mr Blumberg tells me. "It’s not part of their priority. They’re happy and when the workforce is happy they don’t mind if anybody is doing anything for them or not."

However, according to the diplomatic cables released by Wikileaks, the soothing words of Mr Blumberg do not reveal the whole story. "Dominican unions allege [Grupo M] discriminates against labor organizers, fires their members, and has created a fraudulent "scab union" in order to circumvent the legitimate one", one cable notes. It becomes clear something similar had happened in Haiti. Grupo M did have a stronger union once - before it was busted after trying to exercise its rights. Just months after Codevi opened, the workers began complaining of "exploitation and mistreatment" by management of the Grupo M. Rounds of strikes and violence by union members were followed by a "series of employee terminations by the company throughout that summer."

Mr Blumberg explains it thus: "When we had the first union, there was a lot of growing pain. They didn’t have the right groups guiding them, there were a lot of radicals, a lot of leftists." But, he adds: "In the end, everything was straightened out and we’re in peace and we’ve fine with the union." The union had been co-opted. Workers' rights would not be a high priority for the economic model that would design the new Haiti. In fact, the plan was predicated on the lack of rights for workers. In an internal IFC document that was presented to the Haitian government, the administration is implored to amend the labour code in order to "lift restrictions on 24/7 multi-labor shifts" while "streamlining" the process by which night-time salary supplements can be done away with.

The plan was also predicated on a lack of tax revenue. Another incentive for the foreign companies conjured was the so-called "economic free zones" (EFZs), which would offer companies tax and duty-free rights if they set up operations in Haiti. In truth these zones were not real in physical space but rather constituted the whole country. In other words, Haiti would now be tax-free for foreign investors - further disabling the Haitian government's ability to rebuild any public institutions. For example, in 2011, the Haitian government brought in an estimated $1bn a year in revenue, much less than the per-capita rate in sub-Saharan Africa.

The answer to this dillema for the IaDB was the "multiplier effect" whereby companies supplying services to the population would in turn have more income and therefore pay more tax to the government (sometime in the distant future). "It’s on that side that we see the benefits of anchoring in the zones and having these companies come, even if under the current regime they do not pay taxes for a while", says Mr Almeida, IADB country director for Haiti. The idea essentially is that around the industrial estates other smaller Haitian businesses - like travel agents and grocery stores - will pick up the slack of lost tax revenue.

The problem for the IFIs was that even with slave wages - and lax labour regulation - it was proving hard to attract foreign investment. In the face of such reticence from investors around the world, Haiti should have focused on building indigenous capacity, perhaps through a massive public-works initiative and the construction of state-owned facilities, like Sonapi. Haitians were instead again put at the mercy of international capital and its "race to the bottom". For the US embassy, the only thing going for Haiti was that its people were made to work for peanuts. "Haiti has the lowest wages in the western hemisphere", boasted one US embassy cable. To Haitians it was nothing to BOAST about. Camille Chalmers, a local economist, told the Financial Times that the wages paid in the textile sector, Haiti’s biggest industry, were a "veritable scandal".

Amid manifold reservations from both international investors and labour-rights groups, the IADB and the United States Agency for International Development recently finished the construction of the flagship project in the economic reconstruction of Haiti: the Caracol industrial park (CIP), just forty miles down the well-paved road back toward the northern capital of Cap-Haïtien.

The CIP is inspired by the perceived success of Codevi, with those designing Haiti’s new-look economy trying to attract investment with the benefits that drew Grupo M into the economy: cheap labour and geographical closeness to the US, the world’s largest market, where its exports are duty-free. It is one of five planned. The US has poured millions of dollars into the NIP, but only Sae-A Trading, a South Korean textile company, has been enticed to set up shop in the park (and according to people involved in the deal, Sae-A were promised a rent-holiday of four years).

The fact that the US taxpayer is building industrial parks for the benefit of South Korean companies has also raised eyebrows. The US may be the most active foreign country involved in the reconstruction, but even its companies are still keeping their distance. "We are professional beggars", Mr Aguerre, the Haiti manager for the IADB in Washington, tells me. Haitian people would be beggars too. For example, the internal IFC documents on proposed IEZs argue that the reconstruction should be "propelled by private-sector-led development" even though the same document admits "the existing Haitian Free Zone, Industrial Park and Investment Code policy and regulatory regimes have not been effective in attracting investments that are needed to create jobs".

There is another downside, namely that offering generous inducements to foreign companies will adversely impact businesses already in Haiti. Grupo M, for example, is fearful of what the incentives offered for the CIP and other IEZs being planned might mean for them. "[New foreign companies] have to train their workforces, they have to prepare themselves for what is coming", says Mr Blumberg, vice-president of sales at Grupo M. "We want a level playing field if you will. We understand that [foreign companies] are getting a lot of things via grants and via sponsorships from different sources."

But if investment is not forthcoming or indigenous industries flee, as many predict, Haiti will suffer stagnation and destitution for another generation. Enthusiasm from donors for aid and other forms of sovereign investment is now dwindling as the international community loses interest and financial crisis continues to bite. The Haiti Reconstruction Fund (HRF), which aggregates funds from countries and NGOs to fill gaps in investment, has raised $352m so far, but that’s the peak. "We’ve reached a plateau", Mr Leitman, head of the HRF, tells me. "I think the donors have been cautious and reluctant to contribute new money." In March 2010, at the major pledging conference held in New York City, $4.6bn was promised for the first two years of reconstruction. Only $1.9bn of that ever materialised.

The agriculture alternative

Haiti is a notoriously difficult country to operate in: its institutions are frail, weakened by years of underinvestment, and system is riven with corruption. For the economic managers post-earthquake this was the default reasoning for their reliance on the private sector and "export-led" reconstruction. But there was nothing inevitable about such a programme. There were plenty of reconstruction plans that could, most likely would, have created a fairer and more sustainable future for Haitians. The problem was and remains that these plans go against the strict ideology that imbues the Bretton Woods institutions.

For example, the Haitian government could have rebuilt the country’s crumbling infrastructure with a modern-day equivalent of the Marshall Plan from donors, which would have created public-sector jobs for Haitians to construct roads, ports, and energy infrastructure which has either been non-existent or in disrepair. Everyone, after all, puts infrastructure as among the top problems for making Haiti work. 10,000 jobs could have been created just clearing the rubble. The Red Cross has, for example, created hundreds of jobs for Haitians reusing the rubble to build bricks and other building materials, clearing the city and creating employment. "We’re the only ones doing it", the co-coordinator of the programme in Port-au-Prince tells me. "At the moment, now, all the rest goes down the dump, and the cost of processing it is about the same as taking it down to the dump."

Perhaps most importantly, Haiti could have focused on creating a new agrarian economy, a sector which been thriving before President Clinton dumped tonnes of cheap US rice in the country in the 1990s. (About 60% of the Haitian population, or 4 million people, live in rural areas). Promoting community-owned agricultural land would instantly depopulate the overcrowded capital and provide a sustainable way of feeding its people (with any leftover ready for export). It was never even discussed. "Agriculture is still missing", Mr Naim at the IFC tells me. The IFC is yet to make one loan to an agricultural small or medium-sized enterprise (SME), instead training its focus on agribusiness rather than the smallholders that Haiti needs. Likewise, the World Bank admits to me that not enough priority is being given to agriculture. It has put $55m into a new agricultural programme (in the grand scale of things in Haiti, peanuts). "This is our first true agricultural project", acknowledges Mr Abrantes.

The US government claims it is not ignoring agriculture. The ambassador to Haiti tells me the US has invested $200m in the sector already; but once again, the focus remains on produce for export as opposed to providing for the Haitian population, large portions of which are starving. The IADB, on the other hand, contends that infrastructure is important but "there are other needs" (like "investing in the private sector" in order to import seeds). The bank has a plan to get a private company to buy the mangoes, centralise them, distribute them and then send them to the exporters.

"We’re changing the dynamics of how we can do agriculture in Haiti". says Mr Almeida at the IADB. This new dynamic is straight out of the neoliberal guidebook: providing vouchers to small producers so they can buy seeds through imports. With no public or community held land, such ventures have to date not got very far. "It’s not a big number of jobs", Mr Almedia admits. The internal Haitian market remains completely ignored by all parties, a travesty considering that 90% of eggs and poultry consumed in Haiti come from the Dominican Republic, while 80% of rice is imported. Changing that state of affairs through publicly funded subsistence farming is not an option. "When I say agriculture I say agribusiness", says Mr Almeida.

An emblematic project of this "new dynamic" was brokered by the IADB: an initiative with Coca-Cola who have created a new soda called "Mango-Tango" which will be supplied with mangoes from newly developed producers. A similar deal with Starbucks coffee seeks to transform individual micro-farmers into cooperatives and then supply coffee to Starbucks and market it as Haitian coffee. Critical analysts call this the "sweatshops and mangoes" development model. "They need roads, they need irrigation in the countryside, but that’s the one thing these guys won’t do", argues Mark Weisbrot, an analyst at the Center for Economic and Policy Research.

But the Martelly administration’s agriculture policy has so far followed the export-orientated agribusiness model of the Bretton Woods institutions to the book. "What I hear from [the Haitian government] is that they want to go into the export mode, including the agriculture", says Mr Abrantes. In fact, Martelly had pushed the IFIs to go even further. "We were preparing traditional agriculture projects for Haiti which were basically focused on poverty alleviation, on the small farmers", adds Mr Abrantes. "When the Martelly administration came in, they looked at the project and said, ‘We would like it to have a different slant’. We would like to have significant components on stimulating agribusiness, which is quite a different thing from what we had anticipated, and so I think the overall view is, even in agriculture, to encourage parts of the agricultural sector to move into export-production."

Haiti remains a majority agrarian country; it needs an agrarian-based development model that distributes land amongst its homeless people for community-based subsistence cultivation. The economic managers of the country are not interested. The long-held dream of a Caribbean sweatshop is being born instead, and out of one of history’s worst human catastrophes, which this approach will only prolong.

Abstract

Objective To determine whether English regions worst affected by the economic recession in the United Kingdom in 2008-10 have had the greatest increases in suicides.

Design Time trend analysis comparing the actual number of suicides with those that would be expected if pre-recession trends had continued. Multivariate regression models quantified the association between changes in unemployment (based on claimant data) and suicides (based on data from the National Clinical Health Outcomes Database).

Setting 93 English regions, based on the Nomenclature of Territorial Units Statistics level 3 groupings of local authorities at county level and groups of unitary local authorities.

Participants Men and women with a record of death from suicide or injury of undetermined cause in 2000-10.

Main outcome measure Number of excess suicides during the economic recession (2008-10).

Results Between 2008 and 2010, we found 846 (95% confidence interval 818 to 877) more suicides among men than would have been expected based on historical trends, and 155 (121 to 189) more suicides among women. Historically, short term yearly fluctuations in unemployment have been associated with annual changes in suicides among men but not among women. We estimated that each 10% increase in the number of unemployed men was significantly associated with a 1.4% (0.5% to 2.3%) increase in male suicides. These findings suggest that about two fifths of the recent increase in suicides among men (increase of 329 suicides, 126 to 532) during the 2008-10 recession can be attributed to rising unemployment.

Conclusion The study provides evidence linking the recent increase in suicides in England with the financial crisis that began in 2008. English regions with the largest rises in unemployment have had the largest increases in suicides, particularly among men.

Introduction

Few would contest that the UK government’s austerity policy has increased job losses, and indeed, one of its core aims has been to achieve large scale reductions in public sector employment. But what are the implications for health?

This is an important question. A recent report commissioned by the government called for measures that would make dismissing employees easier than it is now, conceding that “some people will be dismissed simply because their employer doesn’t like them,” but arguing that this is a “price worth paying.”1 Although the wording of the report was unusually blunt, it reflected a widely held view among many of the government’s supporters that the answer to the current financial problems was to deregulate labour markets further, with so-called “supply-side” policies that weaken employment protection and obligations in areas such as health and safety. 2 But if these policies are to be pursued, what is the price that must be paid by those who will lose their jobs? Such knowledge is essential before deciding whether this price is worth paying.

A growing number of people may be paying the ultimate price. In 2008, suicides began to rise in England, from a 20 year low,34 increasing by 7% among men and 8% among women from the previous year (fig⇓). Although suicides began to fall again in 2010, they are currently still above corresponding values in 2007.

Trends in the numbers of suicides and unemployment claimants in England, 2000-10, by sex

But can these recent increases in suicide be attributed to the current financial crisis?35 Commentators on an observed increase in suicides in Greece argued that it was a “premature over-interpretation” to attribute this increase to the crisis, since the changes were within the range of annual statistical fluctuations, owing to the small numbers involved.5 Whether health ministers hold the same views about the trends in the UK is unclear since, as far as we know, they have been entirely silent about the factors that might explain the rise in suicides. However, a considerable body of research at the individual level from longitudinal studies indicates that unemployment does increase risks of suicide and non-fatal self harm.6789 Although suicides do tend to increase during economic downturns,10111213 the strength of the association varies among countries, and there is evidence that risks can be mitigated by strong social support and employment programmes.11 Conversely, it is possible that other factors have caused the observed rise, separate from the crisis.

Much of the previous research at population level has used aggregated data from one or more countries.101415These studies often had few data points, lacking statistical power to identify underlying factors. However, in large countries, it is also possible to take advantage of subnational variations,16 offering the benefit of more consistent surveillance systems and ensuring that national level factors, such as legislation changing access to the means of suicide, are kept constant. 17 The current economic crisis in England has been unequally distributed across its regions. Since 2005, the West Midlands has experienced the greatest increase in unemployment (6.1 percentage points), while southeast England has had the least (2.7 percentage points).18 These regional variations provide an opportunity to assess, for the first time, whether the current recession and associated rises in unemployment are significant determinants of rising suicides in England.

In this study, we exploit these regional differences in rates of suicide and unemployment between 2000 and 2010 to test the hypothesis that those regions with greater rises in unemployment have had corresponding increases in suicides. Previous studies in the UK have sought to understand the reasons for a fall in suicides rates from high levels in the late 1990s,19 although none has, to our knowledge, investigated the causes of the current increases in suicide.

Methods

Annual panel data for the number of deaths from suicides and injuries of undetermined cause were obtained from the National Clinical and Health Outcomes Database, covering the years 2000 to 2010.20 We used the start date of 2000 to compare trends over the past decade; however, we replicated our results using the first year (1993), for which data were available from the database. Deaths from undetermined injuries were included, because this category includes cases for which the coroner has given an open or narrative verdict, instead of a classification of suicide. Since there is a great deal of variation in the practice of coroners in determining suicide, we included undetermined injuries with suicides, to provide a more consistent measure of all deaths that are likely to be suicides, following conventional practice with government statistics in the UK.21 Data were available for 93 local areas, based on the Nomenclature of Territorial Units Statistics level 3 (NUTS3) groupings of local authorities at county level and groups of unitary local authorities in England. The nomenclature is a geocode standard for referencing the subdivisions of countries for statistical purposes developed by Eurostat.2223 Web appendix 1 provides further details of the datasets.

We measured unemployment as the number of people claiming unemployment benefits within each region, using data provided by the Office for National Statistics. Although this measure does not capture all unemployment, and may understate true unemployment in a period of austerity, it is the most precise and consistent measure that is officially recorded in all regions. Claimant data are also highly correlated with unemployment statistics (r=0.73, P<0.001).

Statistical analysis

The statistical analysis proceeded in two steps. Firstly, we assessed the total excess number of suicides attributable to the financial crisis following standard definitions of excess, by calculating the number of suicides that were over and above historical trends. Here, we used a time trend model to estimate the “counterfactual” rate—that is, what the rate would have been had trends continued to decline at the pre-crisis rate. A dummy variable for the crisis years of 2008-10 was included in the model to capture a break from past time trends. To simplify interpretation, we modelled numbers rather than rates, although our conclusions did not change substantively when using rates. To increase precision, we modelled the excess number of suicides in the recessionary period of 2008-10, although results were similar when evaluating each year separately.

In the second step of the analysis, we assessed the association of changes in unemployment (that is, new job losses rather than long term unemployment, reflecting evidence that it is the transition in employment status that is important) with suicides, stratified by region and sex using linear regression models. At the ecological level, there is potential confounding from unobserved factors that vary between local authorities; therefore, we used a fixed effects approach to remove these between local authority differences.24 This conservative approach involves including dummy variables for each NUTS3 area to assess the association between deviations from the average rate of change in unemployment and deviations from average rate of change in suicides in each NUTS3 area. We used robust clustered standard errors to reflect the fact that populations were not sampled independently and to ensure that standard errors were robust to serial correlation in the data. Models were used to estimate the suicides attributable to changes in unemployment in the 2008 recession. All data and models were estimated using Stata version 12.

Results

Total excess suicides during the recession

Before the economic crisis in 2008, the rate of male suicides was declining in England by 57 suicides per year (95% confidence interval 56 to 58), from 2000 to 2007; female suicides decreased by 26 suicides per year (24 to 27) in the same period (table 1⇓). We estimated 846 more suicides among men (818 to 877) and 155 more suicides among women (121 to 189) than would have been expected if these trends had continued in the period 2008-10.

Time trend analysis of excess suicides during the economic recession in 2008-10, by sex

Annual associations of suicides with unemployment by sex and region

As depicted in the figure, and as is evident across English regions, levels of unemployment correlated strongly with suicides among men and women in the period studied (rmale=0.73, P<0.001; rfemale=0.68, P<0.001). To assess the specific effect of job losses during the recession, rather than long term unemployment, we evaluated short annual changes in unemployment. Table 2⇓shows the associations between short term changes in job losses and suicides. Between 2000 and 2010, each annual 10% increase in the number of unemployed men was associated with a 1.4% increase in the number of male suicides (95% confidence interval 0.5% to 2.3%). Among women, however, these short term associations were not significant (0.7% increase, −1.5% to 3.0%).

Association of unemployment with suicide rates (%) in 93 local areas of England in 2000-10, by sex

With our estimates of total excess suicides and the association between unemployment and suicide rates, we estimated the portion of excess suicides attributable to unemployment. Relative to 2007, the number of unemployed men rose on average across English regions by 25.6% each year in 2008-10. Based on our models, this increase in unemployment was associated with yearly increases in male suicides of 3.6%. This percentage rise corresponds to 329 (95% confidence interval 126 to 532) additional suicides between 2008 and 2010, accounting for about two fifths of the total excess suicides among men during the recession.

Robustness tests

To determine whether the association between unemployment and suicides in the recessionary period differed from past trends during periods of economic growth, models were disaggregated by time period. The significant association between unemployment and suicides among men remained after we analysed separately data from 2006 to 2010 (when unemployment was rising) and before 2006 (when unemployment was falling; web appendix 4). We saw no significant difference in the size of association during these two periods (test for effect heterogeneity, P=0.35).

We tested the robustness of our estimates using alternative assumptions: removing observations with large year-to-year fluctuations in suicides (>150%); fewer than 10 suicides per year; and standardised residuals of an absolute value greater than 2. None of the re-estimated results changed under these assumptions. Since the variance in the change in suicide rates depends on the number of suicides in each area, we also estimated models using weights for the annual mean number of suicides in each area. Again, none of the results changed. Unadjusted associations yielded stronger effects (web appendix 2). Lastly, we investigated lead and lagged effects in the first and second year, finding no significant effects (web appendix 3). We also did statistical models without adjusting for time trends and used the longest time series available from 1993, finding similar results (web appendix 4). Estimated associations of unemployment with suicides were similar after excluding undetermined injuries from suicide calculations (web appendix 5).

Discussion

Our study estimated that the recent recession in the UK has led to about 1000 excess suicides in England: 846 among men and 155 among women. Our analysis indicates that increases in male unemployment were associated with about two fifths of these rises in suicides among men in England during the current recession. Local areas with greater rises in unemployment have also experienced higher rises in suicides, although this level was significant only among men, possibly because the suicide rates among women are only about a third of those among men. On its own, our study cannot ascertain whether the association between job loss and suicides is causal; however, the strength of the effect size, timing, consistency, coherence with previous research, existence of plausible mechanisms, and absence of any obvious alternative explanation suggest that it is likely to be.25Importantly, these findings can explain why there was a small reduction in suicides in 2010, which coincided with a slight recovery in male employment.

Limitations of the study

Before evaluating the implications of our findings, we must note several important limitations. Firstly, we undertook an observational analysis at the population level; however, in contrast with previous work, we were able to take advantage of subregional variations in unemployment and suicide rates. Nonetheless, the analysis of subregional data still cannot account for potential differences across employed and unemployed groups, and results could indicate increasing risks among both groups during economic downturns (for example, as a consequence of uncertainty about the future among employed people). Furthermore, within local areas, there may be differences in the share of the population most vulnerable to the effects of unemployment, such as people with low levels of education or with pre-existing mental health problems.826

Secondly, we measured unemployment using the number of claimants, which could underestimate the true number of people who cannot find work. To claim unemployment benefits, people must meet certain criteria, such as be capable of work, be available for work, actively seek work, as well as fulfilling contributory or means testing requirements. Thus, some people may leave the employment market altogether rather than attempt to claim benefits.27 Alternative measures, such as the Labour Force Survey, would not provide sufficiently detailed data for geographical analysis.

Thirdly, suicides measure a very small portion of the overall health consequences of unemployment.28 Fourthly, analysis of suicides in small areas must be interpreted with caution because of the varying use of narrative verdicts by coroners and the difficulties in translating coroners’ verdicts into codes according to the International Classification of Diseases.21 However, our inclusion of injuries of undetermined cause should have largely dealt with this problem, and such biases are probably relatively constant over time, making estimates of changes within regions more consistent for testing our study’s hypothesis. Finally, our estimates of the risks of suicides attributable to unemployment were based on the contemporary period, because we did not observe significant lead or lagged effects.

Policy implications

Our analysis, coupled with evidence from other studies,11 has several implications for those seeking to protect the most vulnerable people in the ongoing economic recession. Firstly, our study indicates that although the initial economic shock of recession does increase suicide risk, policies that promote re-employment could reverse this trend. However, forecasts for economic growth over the next 10 years in the UK indicate that employment is unlikely to return to levels before the recession until after 2017.29 Overall, women seem less likely to inflict self harm in response to unemployment, suggesting an increased degree of resilience among women, which has been identified in other European countries.30 Our study may have lacked sufficient power to detect an effect in women, if this effect size was small. An enhanced understanding of the role of responses from each sex may help mitigate risks. However, more research is needed to understand why suicides have risen recently among women, in view of the absence of an association with their employment.

Secondly, budget cuts could exacerbate the consequences of the ongoing economic recession, both by increasing losses of public sector jobs (and those in the private sector that they support) and by reducing access to preventive services. Austerity measures in the UK are exacerbating unemployment and reducing growth,31 and some commentators have suggested that the government should promote employment, particularly in deprived areas, through state led social investment in infrastructure, industry, education, early years support, and improved working conditions.32 Cuts to local authority budgets in England have been greatest in more disadvantaged areas33 with higher suicide rates. Recent increases in unemployment between 2010 and 2011 are also significantly correlated with local authority budget cuts (correlation coefficient between reduction in spend per head of population and increase in male claimant rate, r=−0.21, P=0.0026; authors’ calculations).

Unemployment and the unequal economic recovery in England are pressing public health issues.34 The total cost of suicide in Ireland, for example, was estimated to be about 1% of the country’s gross domestic product in 2002.35 There is a danger that the human cost of continued high levels of unemployment will outweigh the purported benefits of budget cuts.

What is already known on this topic

In 2008, suicide rates began to rise in the United Kingdom, reversing a long term decline

It is not clear whether this increase can be attributed to the economic recession of 2008-10

What this study adds

English regions with the largest rises in unemployment have shown the largest increases in suicides, particularly among men

Notes

Cite this as: BMJ 2012;345:e5142

Footnotes

Contributors: BB and DTR collected the data and originated the study. BB, DS, and DTR contributed to the analysis and interpretation of the data. All authors contributed to the writing of the manuscript. BB is the study guarantor.

Funding: BB is supported by a National Institute of Health Research fellowship and DTR is supported by a Medical Research Council fellowship.

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Ethical approval: Ethical approval not required.

Data sharing: The dataset used for the analysis and statistical code are available from the corresponding author at benbarr@liverpool.ac.uk.

Monday, 3 September 2012

When I left my marriage, I severely mourned the death of my relationship. My mourning for the fantasy relationship was as real as any grief I’ve ever felt. The grief was so real it led me to delude myself about the truth of my abusive marriage. Will, my husband, wasn’t all bad, was he? Maybe our separation would scare him straight, maybe our recent civil conversations heralded a new beginning for us, maybe this was all a bad dream. These thoughts of hope led me down a fanciful path of wishful thinking. Before too long, I found myself in “Willy-Land” – the magical fantasy place where all was right in our marriage because Will said so. I imagined our relationship filled with roses and sugar, more good than bad, more love than hate. I thought that just maybe I had imagined everything! I put on my rose-colored glasses and remembered our wedding day, our sons’ births, and family celebrations with bittersweet angst.

He said that he wouldn’t function without me, could never love anyone else ever again, and that I was perfect and irreplaceable. He seemed larger than life and I thought he loved me more than anyone ever could. He needed me and I needed him and true love conquered all pain. I carried those loving feelings and applied them to him during conversations we were having in the present. I believed he was loving and kind and that we would work “this” out.

And then my fantasy bit me on the butt.

Fantasy Leads to Pain

Will used my fantasy against me. He asked to meet and discuss custody issues. I heard “meet and discuss us“. I became excited about seeing Will, and hoped that our meeting signaled the end of our separation. I built it up to Gone With The Wind proportions.

It wasn’t what I’d imagined. This time, I’d gone to Willy-Land on my own because I wanted to believe the delusion that Will loved me. The meeting turned nasty almost right away and the pain of “failure” struck me a hundred-fold.

Back to Reality

After that meeting, I continued to grieve for the fantasy relationship, but now I recognized it properly. My wishes and desires for a loving relationship with Will would never come true. Willy-Land was an illusion, a false promise of happiness. I mourned a relationship I would never hold, much like I mourned my miscarried babies of years past.

Over time, the mourning and sadness ended, but time wasn’t the only thing I needed!

I needed to get past the sadness sooner than time would allow because I had to face Will in court and when we passed the children between his place and mine. I needed to be better NOW, and if I couldn’t truly be “better” then I needed to pretend I was so he wouldn’t know how weak I felt inside. If he knew how weak I felt, he would use it to his advantage.

Fake It ‘Til You Make It

I decided that no matter how I felt inside, I would project an image of confidence and happiness when we talked on the phone or met up with one another. To do this, I watched confident women on television (Angelina Jolie has this all wrapped up!) and read books about abuse for hints of what life without abuse was like.

Then I copied what I saw and read.

I answered his calls with a smile.

I hung up when he got abusive.

I strode confidently toward my boys in the parking lot, hugging them and smiling at them (even though I was terrified of looking at their father).

When I did see my husband, I looked right into his eyes and smiled. It threw him off.

If he started being abusive, I said, “I don’t have time for this” and walked away.

In the beginning I would break down in tears and fear as soon as I was alone. Now I don’t have to fake it anymore. ”Faking it” made me understand that he never knew what went on inside my mind. Back in the day, I thought he could read my mind, but he was only reading my actions and interpreting them well. Faking helped dispel his illusion of control and my fears.

Purposefully Push Out The Fantasy

Toward the end of my marriage I was an expert in recognizing his abusive tactics. Recognizing it in him helped me to see when I started to abuse myself with irrational fantasies. When I felt myself heading to Willy-Land, that place of fantasy and wish-it-were, I would forcefully change my thinking.

When I noticed myself drifting, I told myself “Stop It!” and surprisingly, the same thing I once said to him helped me! After stopping the wrong thinking, I replaced it with something better or went to do something else.

Some people say to make a list of all the hateful things you can remember and read the list when you consider returning to your abuser. I don’t like that idea because it tends to re-traumatize us to remember the horrid stuff. Traumatized people do not successfully fake it ’til they make it OR push fantasies from their mind.

So, I replaced the old fantasy with a new one. I wrote a list of qualities I was looking for in a person. At first, the only thing that came to mind was “He never hits me!” After getting the abusive crap out of the way, I found myself writing stuff like, “He loves to talk to me during dinner and sometimes we sit for hours talking about our dreams for the future.”

When the old fantasy threatened to carry me away, I pulled out my new list, read it and felt it until it became stronger than any abusive fantasy relationship I could imagine.

“Faking it” and my new fantasy helped strengthen one another. Eventually I was strong, happy, and confident. And, believe it or not, I also eventually met someone who embodies every characteristic I wished for.